Last week, the column on depression pointed out that the basis of the problem was a mismatch of reality and expectation.  We all have disappointments, some larger, some smaller.  Small disappointments are often brushed aside, being of little consequence.  But major disappointments, such as a loss of a loved one, will have disabling effects upon the individual encountering the disappointment.

     Grief reactions that occur with the loss of loved ones are an expected and natural phenonomen.  They will run their course in time and normal individuals eventually return to normal function.  Even though the person’s function maybe severely impaired during this grief reaction, this would really not be called an illness and is best not treated. It is best allowed to run its course with the counsel of friends and other loved ones. Grief reactions cannot be classified as “depression”.

Depression is an abnormal state.  The textbooks of psychiatry divide depression into various different types. One type is bipolar disorder in which the person is uncontrollably happy and euphoric and then uncontrollably depressed. Other forms of depression include dysthymia, where the person remains inactive, sad and nonfunctional over an extended period of time. There are differences in depressions that occur in the adolescent and in the aged.  There are special forms of depression such as post-partum depression that occurs in a mother a few months after the child’s birth.  While each of these types of depression might be treated a little differently, there is a common denominator thought disorder that seems to permeate them all.

     The first part of the thought disorder is what might be called global thinking.  Individuals with global thinking believe that they are no good at anything.  They can’t run, they can’t sing, they can’t dance.  They are no good at math, they are not physically attractive, or they are too heavy or too thin.  If they flunk a test, it is because they are no good at anything.

     Opposed to this is the individual who may believe that they are deficient in some event- specific situation.  Examples would be the person who does poorly on math exams.  The non-depressed person believes that they may not be very good at math but they are good at other things, such as writing or dancing or conversation, etc.  The global-thinking individual is unwilling to try other things, whereas the event-specific individual is willing to take on other endeavors at which they might be successful or not.  They are willing to try.

     The second characteristic of the depressed individual is the permanence of their belief.  The depressed individual believes that they will never recover from the events that have occurred to them.  This leads to a giving-up mentality.  The events-specific individual recognizes that they have flunked their math test but they will do better in the next test. They will be successful in other areas.  They believe that they will recover from whatever event has occurred to them.

     The last characteristic of the depressed individual is their belief that their deficiencies are personal.  They feel that whatever deficiencies or failures they have are due to the depressed person being inadequate and incapable.  Opposed to this position is the individual who failed their math test because they didn’t study hard enough or didn’t study a section of the book from which the test came or perhaps they would believe that they were overtired at the time the test was taken.  The non-depressed individual believes that they are capable of passing the math test under the right circumstance.  The depressed individual feels that they will never pass the math test because they are basically incapable at anything that they might attempt.  The depressed individual’s thinking is global, permanent, and a result of the depressed person thinking and feeling inferior.

     The depressed individual is mired in the past.  They do not generate future plans since that would be of no use.  An intrinsic requirement of getting out of the depressed state is the recognition of the need to face the future.

 The value of this information lies in its therapeutic implications.  If the thought processes maintaining the depression can be recognized, then correction of the destructive thought patterns can be addressed.  The best way to recognize the destructive thought patterns is to “talk it out”.  Many years ago, a study was done comparing the effectiveness of friends, professional psychological counselors, and clergyman, and their ability to help individuals who were depressed.  It was found that there was no significant difference in the effectiveness of these three groups.  Even though friends had no formal training in counseling depressed individuals, they seemed to be every bit as effective as clergymen or professional counselors. The friend has to be someone who is trusted, non-judgmental, “a good listener”, and has the time to devote to their friend.  Such individuals are obviously few and far between.

     When “talk treatment” is ineffective or unavailable, the use of medications to help the depressed individual provides a second choice either by themselves or in addition to “talk treatment”.  Next week’s column will be devoted to the different types of medication available, their expectations and side effects.